在个性化激素替代疗法冷胚胎移植 (HRT-FET) 协议中,直肠发育激素的使用确保了高持续怀孕率:一项前性干预研究
B Alsbjerg1,2, M B Jensen1, B B Povlsen1
1The Fertility Clinic, Skive Regional Hospital, Skive, Denmark.
Human reproduction (Oxford, England)
|September 27, 2023
概括
在接受激素替代疗法冷胚胎移植 (HRT-FET) 的患者中,直肠孕激素补充剂有效地维持高持续妊娠率 (OPRs),在移植日血清孕激素 (P4) 低. 在这种情况下,这种方法为改善生殖结果提供了可行的解决方案.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 辅助生殖技术 (ART) 是一种辅助生殖技术.
背景情况:
- 在荷尔蒙替代疗法冷胚胎移植 (HRT-FET) 周期的植入前阶段,血清孕激素 (P4) 水平较低会对生殖结果产生负面影响.
- 虽然皮下孕激素补充可以提高低P4患者的活产率 (LBRs),但仅增加阴道孕激素并不能提高LBRs.
- 输入直肠的孕激素是不太常见的ART途径,尽管吸收良好,P4水平迅速增加.
研究的目的:
- 调查直肠孕激素补充是否可以实现高持续怀孕率 (OPRs) 在血清P4低的患者在胚胎囊移植 (ET) 的一天.
主要方法:
- 一项前性干预研究,涉及488个HRT-FET周期.
- 患者接受标准雌激醇和阴道孕激素 (每天两次400毫克).
- 在ET日血清P4<35nmol/l的患者从ET日开始接受"救援"直肠孕激素 (400毫克每天两次).
主要成果:
- 在488个周期中,23% (114名患者) 的血清P4值为<35nmol/l.
- 12周后的OPR在P4≥35nmol/l组中为45%,在接受直肠救援的低P4组中为46% (P=0.77).
- 总妊娠损失率在各组之间是相似的 (30%对34%,P=0.53).
- 逻辑回归表明年龄和胚胎囊得分是OPR的独立预测因素,而不是BMI或玻璃化日.
结论:
- 从ET日开始的直肠孕激素的使用有效地确保了HRT-FET患者的高OPR,患者的血清P4水平较低.
- 这种直肠补充策略似乎能使最初P4低的患者的生殖结果正常化.
- 直肠孕激素是一种方便,具有成本效益的选择,可以改善特定患者群体的ART结果.
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